Editors' note:Robert-Jay Green is distinguished professor in the PhD clinical psychology program at the California School of Professional Psychology and executive director of the Rockway Institute, a national center for LGBT psychology research, education & public policy.

The California Supreme Court ruled that Proposition 8, which eliminated the right of same-sex couples to marry in California, is constitutional. While the decision and its political ramifications will be debated endlessly, there is another effect of the ruling that has not received attention - the harsh mental health impact on lesbian, gay, bisexual, and transgender (LGBT) single individuals, couples, and their families and friends. As we adjust to the political reality that a slim majority can eliminate marriage rights for a small minority, let's not kid ourselves about the human costs of this outcome.

We've all heard in the media about the extensive research showing that heterosexual marriage is associated with better physical and mental health, greater relationship stability and financial security. The obvious question is why marriage would not benefit same-sex couples just as much. But there is another research story the public doesn't seem to know about--the mental health consequences of granting versus denying marriage to LGBT people. For LGBT citizens who seek nothing more than equal opportunity to benefit from marriage, campaigns of marriage exclusion exact a heavy toll on their well-being.

Research in Massachusetts after legalization of same-sex marriage in 2004 found that lesbians and gay men viewed their choice of partners and relationships very differently when marriage was possible. When a long-term marital commitment was involved, potential partners were judged on very different criteria than when couple commitments lacked legal definition and a sense of permanence. Same-sex partners who married in Massachusetts felt their commitment was more visible, more valid, and more solid. They also felt more accepted and less marginalized by their society. One told researchers "my relationship counts, and I count, too."

In Vermont, where civil unions were approved in 2000, researchers found that same-sex partners in legally recognized couples were more open and had better relationships with their families. Same-sex couples with Vermont civil unions were more likely to stay together over time than same-sex couples without civil unions.

But perhaps the biggest untold story is about the effects that the denial of marriage rights--especially through voter initiatives--is having on LGBT citizens. Researchers in Tennessee found that a 2006 anti-same-sex marriage initiative there caused LGBT residents to feel more psychological distress. The campaign for the initiative provided "constant reminders that (LGBT people) were seen as less than human by their government and the public." LGBT people reported their lives had been "frequently and publicly misrepresented to advance hostile political campaigns."

The increased stress was reflected in greater fears of rejection and hyper-vigilance to protect oneself against random acts of prejudice. Some chose to isolate themselves. Others chose to become activists in an attempt to gain some sense of control under the circumstances.

In a broader survey conducted in many states, social scientists at the University of Kentucky found "increased minority stress and concurrent psychological distress... following passage of a marriage amendment in (participants') state of residence." A study at the University of Memphis also found that anti-LGBT movements and policies negatively affected "participants' personal relationships, mental and physical health, perceptions about their country and government, and hopes for the future."

At the end of the whipsaw of events surrounding Proposition 8, these are the terrible questions that nag at night: Are those who supported Proposition 8 so smug or out-of-touch that they are not even aware of the harmful effects on LGBT people of hearing constant anti-gay public statements over the last 12 months? Do they view LGBT citizens as real people or merely as pawns in a rhetorical quest for moral superiority? Do they care what happens to that young woman and young man who hope to meet and marry the love of their lives one day and become full-fledged equal citizens of the United States?

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Regarding the last part, about stress caused by anti-gay campaigns, I read a similar study conducted after the Amendment 2 campaign in Colorado that found gay people there experienced symptoms of psychological trauma.

I think at the end of the day, the people who vote for things like Amendment 2 and Proposition 8 either don't bother to think that they're hurting real human beings because defending "marral valyas" is far more important, or they know but don't care and even enjoy it.

I'm almost done reading David Neiwert's book "The Eliminationists: How Hate Talk Radicalized the American Right." He occasionally goes into liberal grandstanding that kind of diminishes his objectivity, but if you can ignore that, he makes a pretty good case for the idea that "eliminationist" rhetoric and action have been infecting the right for the past several years, and it's a foregone conclusion that anti-gay campaigns are but one of the latest manifestations of that. He looks at the history of eliminationism in America -- particularly ethnic cleansing of Native Americans, oppression of blacks and exclusion of Asians -- and the rhetoric that has always accompanied it, which invariably has called for "protection" from the looming menace of the other.

Looked at in this context, it's a lot easier to discern where things like Proposition 8 come from.

Bingo! the answer is they are so smug and unaware that their bigotry is costing them money. By limiting marriage, or domestic partnerships which are equivalent, the United States is losing the talents of some of the best people in the world. That is not because they are LGBT, but because they will become motivated fully enfranchised new citizens.

You write:
"When a long-term marital commitment was involved, potential partners were judged on very different criteria than when couple commitments lacked legal definition and a sense of permanence." Ah, well, if marriage is what it takes to endow a "sense of permanence," the problem may not be marriage, yes? If a piece of paper is what it takes for you (and here, please note, I use the generic "you") to understand the depth of your relationship, your relationship problems may be deeper than you think.

As for the bit about, "extensive research showing that heterosexual marriage is associated with better physical and mental health, greater relationship stability and financial security." The validity of those studies has been disputed in Bella DePaulo's book, Singled Out. Even putting aside their validity for a bit, I'm struck by the ways in which we ignore some basic issues. If there is great better physical and mental health, or financial security, perhaps that's because married people, in this country, often have health insurance and other benefits that they can share with their spouses. Their increased happiness, mythical or not, does not come about because marriage inherently makes you a more financially secure and healthier person. And surely such claims, even if true, point to the failure of a society that does not permit single people who are NOT married to people with health care etc. to live secure of their well-being.

The lesson in all of this should be that we ought to stop prioritising marriage as the way to gain happiness, instead of perpetuating the idea that marriage is the key to happiness.

I do get that the onslaught of criticism of gay people by the right can have long-term harmful effects. But to make a connection between that and the justification for marriage as a key to mental, emotional, and economic well-being is putting the cart before the horse.

As for the rights of citizenship - again, you're not required to be married to be a citizen. Sounds obvious, I know, but it's a useful reminder that we can't equate marriage with the benefits that the state should give to everyone, regardless of their marital status.

If there is great better physical and mental health, or financial security, perhaps that's because married people, in this country, often have health insurance and other benefits that they can share with their spouses. Their increased happiness, mythical or not, does not come about because marriage inherently makes you a more financially secure and healthier person. And surely such claims, even if true, point to the failure of a society that does not permit single people who are NOT married to people with health care etc. to live secure of their well-being.

Even though I'm a strong supporter of the freedom to marry, I think that health care in the U.S. should be shifted to a single-payer model. No one should have to rely on employment or marriage for access to care.

That being said, I think that there are other mechanisms at work that could make married partners happier and healthier.

Having a greater sense of permanence (whether ultimately realized or not) would lend a greater weight of investment in the happiness and well-being of oneself and one's partner. A sense of longer time horizon and greater commitment have consequences. Think decreased drug use, better diet, more regular medical checkups, the "marital insurance benefit" of having a prime care-giver: one's spouse.

Granted, there's wide variation amongst couples, but these seem to me to be sensible mechanisms to explain the findings, beyond the availability of health insurance.

But don't forget how lives are silently being destroyed every day, as in "What happens to some individuals when couples whom have lived together for 5, 10, 20 years split up and one person is able to TAKE ADVANTAGE of their lack of legal responsibility to the other person?". For some, it is utter devastation and it can CAUSE more mental health issues, along with financial ruin. And from what I see at our local Interfaith Clinic, there seems to be a noticeably LARGER amount of LGBTQ's who are seeking mental health help. Some, like myself, USED to be able to work and contribute to society, but now they are 100% dependent on welfare and tax dollars. Another "cost" to add up, and TOTALLY preventable.

John, one of the reasons I have been so soft on the "m" word is the baggage it brings with it. Mattilda has made a good point about empowerment from a perspective I find very fresh. Whatever new structure evolves I would want it to be one with a 90% success rate for us and let those who marry remain with a 50% success rate. In October I will be 33 years with the same partner. You know something? We always had a way out for either of us if we chose to exercise it because we planned it that way.

If that is less "starry eyed and in love" than we should want to be it is practical for the time and obstacles we knew we had to overcome. I think it is far more valuable to be in love and devoted than just "in love" with someone. It takes a lot more work to be devoted.

I am not being critical of you of course, but of a situation in an non traditional lifestyle that creates additional problems and a lack of social "glue" to hold them together.

One of the reasons I share my story - I'm hoping that other young LGBTQ's will better prepare themselves for long-term relationships and worse-case scenarios. In my case, we ended our relationship amicably; it wasn't until I was already out of the house that things got very dangerous for me. Ironically, the joint stocks my life was threatened over WERE created as my "way out" in case my ex's sons tried to kick me out after his death.

The reality - not all of us grow up with the same "mental health tool-belt" that help us navigate through life. I'm certain I'm not the only LGBTQ runaway and child-abuse survivor who has made some bad choices in partners. Still, if I were a woman married to this man, I would have had that safety net called divorce.

Thanks, Robert-Jay.
Another hidden cost is the cost to glb persons who enter heterosexual marriages as the only "right thing to do" if they want a relationship and raise a family. Eventually, for most of them, their closeted or denied orientation can no longer be repressed and they come out... In addition to the cost of their internal conflict before coming out, there's devastation for the straight spouse after they disclose. In most cases, divorce follows with family breakups that are costly to their children.

If gay and lesbian persons could marry legally, these tragic situations would decrease and the number of healthy marriages increase.